Organization
PAN AM DENTAL LP
Active
Other names
Dental Office
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA MATA (OFFICE MANAGER)
(210) 342-2000
Entity
Organization
Contact information
Practice address
600 DIVISION AVE, SUITE A, SAN ANTONIO, TX 78214-1350
(210) 342-2000
(210) 342-2517
Mailing address
8261 FREDERICKSBURG RD, SAN ANTONIO, TX 78229-3357
(210) 924-7277
(210) 922-5199
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
20173
TX
261Q00000X
Clinic/Center
20176
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155832201
—
TX
Enumeration date
03/27/2007
Last updated
04/25/2012
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